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Objectives
How to assist with setting up arterial line tubing, pressure bag and monitoring system. How to interpret arterial line wave forms. When and how to utilize a R.O.S.E. Drawing blood samples from arterial line. How to properly discontinue an arterial line. Review policies for arterial lines
Goals
Know how to assist with setting up arterial line tubing, pressure bag and monitoring system. Know how to interpret arterial line wave forms. Know when and how to utilize a R.O.S.E. Know how to draw blood samples from arterial line. Know how to discontinue an arterial line. Be able to locate policies for arterial lines.
Allens test
When an arterial line is being placed, an Allens test MUST be completed first. If the test is negative the arterial line can not be inserted into that extremity.
Phlebostatic axis
Pressure bag
The next step is to make sure that the fluids in the pressure bag are at 300mmHg. This ensures a continuous flow at 3-5ml/hr which helps prevent occlusion of the catheter. 0.9%NS should be used in the pressure bag. Make sure the IV fluid bag matches the size pressure bag (liter w/ liter pressure bag, 500ml with 500 ml pressure bag
Zero Referencing
Flush system Level transducer at the phlebostatic axis Turn stop cock off to pt. Remove cap (all caps should be blue dead end caps). Press the red BP-1 square on the monitor Press BP zero When monitor shows complete, turn stop cock back to the original position. Replace blue dead end cap.
Waveforms
The arterial line waveforms will appear red on the monitor. Normal arterial line waveforms look like this..(fig A)
Waveforms
The arterial line SBP and DBP should be calculated from the waveform. This is simply done by marking the tallest(SBP) portion of the waveform and the lowest(DBP). Make sure the monitor is set to 200mmHg
Waveforms
Correlation
Once the arterial line has been set up properly you want to check the correlation between the arterial line and NIBP. This is typically done on the same arm. (Dr. Walters will ask if the pressures were done on the same arm). In normal patients direct arterial pressure is usually 2-8 mmHg higher than cuff pressure.
Correlation
If the wave form is over-dampened check the position of the wrist and arterial line arm board. Sometimes is is just positional. If the arterial line pressure and NIBP do not correlate, always ask the physician which pressure they would like to use.
Correlation
If the waveform is under-dampened (has a whip) sometimes the hertz on the monitor needs to be changed. To change the hertz on the monitor, go to menu, parameter, BP-1, config, the choose either 8 or 6 hertz instead of 12.
R.O.S.E.
If your NIBP and arterial lines do not correlate and there is a whip in the arterial line waveform, apply a resonance overshoot eliminator to the arterial line (R.O.S.E)
Policies
Policies and operating practices can be found on the YRMC intranet. Operating practices used.. PRAC CC B110.10, (BLOOD SAMPLING VIA ARTERIAL LINES) PRAC CC A001.10, (ARTERIAL LINESINSERTION, MANAGEMENT, REMOVAL)
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